title: (99m)Tc sestamibi as a prognostic factor of response to first-line therapy and outcome in patients with malignant lymphoma.
abstract: BACKGROUND
  Resistance to chemotherapy poses a major problem in cancer patients. Although of multifactorial origin, some of the implicated mechanisms also interfere with (99m)Tc-MIBI uptake and retention in cancer cells. The aim of the current study was to investigate the prognostic value of baseline (99m)Tc-MIBI imaging in lymphoma.
  
  
  METHODS
  (99m)Tc-MIBI SPECT was performed in 16 patients with Hodgkin lymphoma and 31 with non-Hodgkin lymphoma (NHL) before chemotherapy initiation. Early (20 minutes), late (120 minutes) tumor-to-background (T/B) ratios, and 2-hour (99m)Tc-MIBI washout were calculated. Follow-up data were obtained for a period of 45.5 ± 23.5 months. Study end points were response to first-line chemotherapy, lymphoma-related death (LRD), and time to disease progression.
  
  
  RESULTS
  Of the scintigraphic indices examined, the late T/B ratio correlated best with study end points. A cutoff value of 1.8 determined by receiver operating characteristic analysis discriminated poor from good response and LRD from survival with an accuracy of 87% and 81%, respectively. Kaplan-Meier survivor functions separated by this cutoff differed significantly for both time to disease progression and LRD (P = 0.0001 and P = 0.0015). In the Cox proportional hazards model, the late T/B ratio proved to have an independent and incremental value over clinical prognostic factors (age, lymphoma type, Ann Arbor stage, lactate dehydrogenase levels) and, in NHL patients, over the international prognostic index. Patients with high international prognostic index score could be further stratified into different prognostic categories.
  
  
  CONCLUSIONS
  The current study indicates that baseline (99m)Tc-MIBI SPECT can provide useful prognostic information in patients with lymphoma, particularly NHL, regarding therapy response and final outcome.
authors.affiliation: From the *Department of Nuclear Medicine, University of Patras Medical School, Patras; †Department of Hematology, University of Larissa Medical School, Larissa; and ‡Department of Hematology, University of Patras Medical School, Patras, Greece.
authors.forename: Trifon J
authors.initials: TJ
authors.lastname: Spyridonidis
authors.forename: Panayota
authors.initials: P
authors.lastname: Matsouka
authors.forename: Argiris
authors.initials: A
authors.lastname: Symeonidis
authors.forename: Christos
authors.initials: C
authors.lastname: Savvopoulos
authors.forename: Pavlos J
authors.initials: PJ
authors.lastname: Vassilakos
authors.forename: Dimitris J
authors.initials: DJ
authors.lastname: Apostolopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008223:Lymphoma / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D011877:Radionuclide Imaging; D017256:Technetium Tc 99m Sestamibi; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D017256:Technetium Tc 99m Sestamibi